Low-molecular weight heparin for pulmonary embolism: a shot in the dark?

Both meta-analyses included large numbers of patients from randomized controlled trials with objectively diagnosed PE or VTE. Quinlan has the advantage of only including trials of patients with documented PE, which more closely pertains to the patient in the clinical question. The study was of excellent quality and showed no difference in rates of recurrent PE or mortality. It supports a trend towards a decrease in recurrent PE with the use of LMWH vs. UFH, without an increased rate of adverse events. The study by van Dongen et al further supports the use of LMWH in the combined group of patients with PE or DVT. Van Dongen shows a decrease in any symptomatic VTE, major bleeding, and all cause mortality in this group.